Cerebral Salt Wasting in Traumatic Brain Injury Is Associated with Increased Morbidity and Mortality

Akella Chendrasekhar,1,2 Priscilla T Chow,1,2 Douglas Cohen,1 Krishna Akella,1,2 Vinay Vadali,1,2 Alok Bapatla,1,2 Jakey Patwari,1 Vladimir Rubinshteyn,1 Loren Harris1,2 1Department of Surgery, Richmond University Medical Center, Staten Island, NY, USA; 2Department of Surgery, SUNY Downstate Medical...

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Autores principales:	Chendrasekhar A, Chow PT, Cohen D, Akella K, Vadali V, Bapatla A, Patwari J, Rubinshteyn V, Harris L
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2020
Materias:	hyponatremia hypovolemia natriuresis traumatic brain injury neurosurgery. Neurosciences. Biological psychiatry. Neuropsychiatry RC321-571 Neurology. Diseases of the nervous system RC346-429
Acceso en línea:	https://doaj.org/article/2663d9f81cdf447d91b2ddef9c1520f9
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spelling	oai:doaj.org-article:2663d9f81cdf447d91b2ddef9c1520f92021-12-02T09:24:01ZCerebral Salt Wasting in Traumatic Brain Injury Is Associated with Increased Morbidity and Mortality1178-2021https://doaj.org/article/2663d9f81cdf447d91b2ddef9c1520f92020-03-01T00:00:00Zhttps://www.dovepress.com/cerebral-salt-wasting-in-traumatic-brain-injury-is-associated-with-inc-peer-reviewed-article-NDThttps://doaj.org/toc/1178-2021Akella Chendrasekhar,1,2 Priscilla T Chow,1,2 Douglas Cohen,1 Krishna Akella,1,2 Vinay Vadali,1,2 Alok Bapatla,1,2 Jakey Patwari,1 Vladimir Rubinshteyn,1 Loren Harris1,2 1Department of Surgery, Richmond University Medical Center, Staten Island, NY, USA; 2Department of Surgery, SUNY Downstate Medical Center, Brooklyn, NY, USACorrespondence: Akella Chendrasekhar Email achendrasekhar@rumcsi.orgIntroduction: In the setting of cerebral injury, cerebral salt wasting (CSW) is a potential cause of hyponatremia, which contributes to adverse effects and mortality.Objective: The primary objective of this study was to evaluate the clinical outcomes of severe traumatic brain injury (TBI) patients complicated by CSW.Methods: A retrospective data analysis was performed on data collected from patients with TBI with an abbreviated injury scale (AIS) greater than 3. Data was divided into 2 groups of patients with CSW and those without. The primary endpoint was incidence of adverse effects of CSW in regard to injury severity score (ISS), hospital length of stay (HLOS), ventilator days, ICU length of stay (ICU LOS) and survival to discharge. Data was analyzed using a one-way analysis of variance (ANOVA).Results: A total of  310 consecutive patients with severe head injury (anatomic injury score 3 or greater) were evaluated over a 3-year period. A total of 125 of the 310 patients (40%) were diagnosed with cerebral salt wasting as defined by hyponatremia with appropriate urinary output and salt replacement. Patients with CSW had poorer outcomes in regard to ISS (21.8 vs 14.2, p< 0.0001), HLOS (14.1 vs 3.5, p< 0.0001), ventilator days (5.0 vs 0.45, p< 0.0001), ICU LOS (8.5 vs 1.6, p< 0.0001), and survival to discharge (88% vs 99%, p< 0.0001).Discussion: Common adverse effects of CSW were noted in this study. Patients with TBI have a predilection towards development of CSW and consequently have poorer outcomes including increased morbidity and mortality. Data is sparse on the duration of CSW and degree of hyponatremia over time. Larger, comparative studies need to be performed to investigate the hyponatremic patient population and the clinical outcomes of those who present with CSW.Keywords: hyponatremia, hypovolemia, Natriuresis, traumatic brain injury, neurosurgeryChendrasekhar AChow PTCohen DAkella KVadali VBapatla APatwari JRubinshteyn VHarris LDove Medical Pressarticlehyponatremiahypovolemianatriuresistraumatic brain injuryneurosurgery.Neurosciences. Biological psychiatry. NeuropsychiatryRC321-571Neurology. Diseases of the nervous systemRC346-429ENNeuropsychiatric Disease and Treatment, Vol Volume 16, Pp 801-806 (2020)
institution	DOAJ
collection	DOAJ
language	EN
topic	hyponatremia hypovolemia natriuresis traumatic brain injury neurosurgery. Neurosciences. Biological psychiatry. Neuropsychiatry RC321-571 Neurology. Diseases of the nervous system RC346-429
spellingShingle	hyponatremia hypovolemia natriuresis traumatic brain injury neurosurgery. Neurosciences. Biological psychiatry. Neuropsychiatry RC321-571 Neurology. Diseases of the nervous system RC346-429 Chendrasekhar A Chow PT Cohen D Akella K Vadali V Bapatla A Patwari J Rubinshteyn V Harris L Cerebral Salt Wasting in Traumatic Brain Injury Is Associated with Increased Morbidity and Mortality
description	Akella Chendrasekhar,1,2 Priscilla T Chow,1,2 Douglas Cohen,1 Krishna Akella,1,2 Vinay Vadali,1,2 Alok Bapatla,1,2 Jakey Patwari,1 Vladimir Rubinshteyn,1 Loren Harris1,2 1Department of Surgery, Richmond University Medical Center, Staten Island, NY, USA; 2Department of Surgery, SUNY Downstate Medical Center, Brooklyn, NY, USACorrespondence: Akella Chendrasekhar Email achendrasekhar@rumcsi.orgIntroduction: In the setting of cerebral injury, cerebral salt wasting (CSW) is a potential cause of hyponatremia, which contributes to adverse effects and mortality.Objective: The primary objective of this study was to evaluate the clinical outcomes of severe traumatic brain injury (TBI) patients complicated by CSW.Methods: A retrospective data analysis was performed on data collected from patients with TBI with an abbreviated injury scale (AIS) greater than 3. Data was divided into 2 groups of patients with CSW and those without. The primary endpoint was incidence of adverse effects of CSW in regard to injury severity score (ISS), hospital length of stay (HLOS), ventilator days, ICU length of stay (ICU LOS) and survival to discharge. Data was analyzed using a one-way analysis of variance (ANOVA).Results: A total of  310 consecutive patients with severe head injury (anatomic injury score 3 or greater) were evaluated over a 3-year period. A total of 125 of the 310 patients (40%) were diagnosed with cerebral salt wasting as defined by hyponatremia with appropriate urinary output and salt replacement. Patients with CSW had poorer outcomes in regard to ISS (21.8 vs 14.2, p< 0.0001), HLOS (14.1 vs 3.5, p< 0.0001), ventilator days (5.0 vs 0.45, p< 0.0001), ICU LOS (8.5 vs 1.6, p< 0.0001), and survival to discharge (88% vs 99%, p< 0.0001).Discussion: Common adverse effects of CSW were noted in this study. Patients with TBI have a predilection towards development of CSW and consequently have poorer outcomes including increased morbidity and mortality. Data is sparse on the duration of CSW and degree of hyponatremia over time. Larger, comparative studies need to be performed to investigate the hyponatremic patient population and the clinical outcomes of those who present with CSW.Keywords: hyponatremia, hypovolemia, Natriuresis, traumatic brain injury, neurosurgery
format	article
author	Chendrasekhar A Chow PT Cohen D Akella K Vadali V Bapatla A Patwari J Rubinshteyn V Harris L
author_facet	Chendrasekhar A Chow PT Cohen D Akella K Vadali V Bapatla A Patwari J Rubinshteyn V Harris L
author_sort	Chendrasekhar A
title	Cerebral Salt Wasting in Traumatic Brain Injury Is Associated with Increased Morbidity and Mortality
title_short	Cerebral Salt Wasting in Traumatic Brain Injury Is Associated with Increased Morbidity and Mortality
title_full	Cerebral Salt Wasting in Traumatic Brain Injury Is Associated with Increased Morbidity and Mortality
title_fullStr	Cerebral Salt Wasting in Traumatic Brain Injury Is Associated with Increased Morbidity and Mortality
title_full_unstemmed	Cerebral Salt Wasting in Traumatic Brain Injury Is Associated with Increased Morbidity and Mortality
title_sort	cerebral salt wasting in traumatic brain injury is associated with increased morbidity and mortality
publisher	Dove Medical Press
publishDate	2020
url	https://doaj.org/article/2663d9f81cdf447d91b2ddef9c1520f9
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Cerebral Salt Wasting in Traumatic Brain Injury Is Associated with Increased Morbidity and Mortality

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